Ankylosis of a knee joint from Medieval London: Trauma, congenital anomaly or osteoarthritis?

OBJECTIVE

To explore the differential diagnoses of a fused left knee joint and the subsequent impairment.

MATERIALS: An adult female skeleton from the Medieval cemetery of St Mary Spital (London, England).

METHODS

We employed digital radiography and macroscopic observation to record the changes observed throughout the skeleton. We also used the Index of Care to explore the subsequent impairment.

RESULTS

A range of congenital and developmental conditions were identified throughout the axial skeleton, with changes to the spine, pelvis, arms and leg bones reflecting adaptation to the mobility impairment.

CONCLUSIONS

In all probability, the left knee reflects a case of congenital ankylosis with a differential diagnosis of subadult trauma. The female's skeleton had adapted to the impairment. Their risk is likely to have been elevated because of climatic and pandemic events during this period.

SIGNIFICANCE: First reported case of congenital knee ankylosis.

LIMITATIONS: The left knee joint was damaged during excavation.

SUGGESTIONS FOR FURTHER RESEARCH: Additional imaging is advised.